97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB1562

 

Introduced 2/15/2011, by Rep. Kay Hatcher

 

SYNOPSIS AS INTRODUCED:
 
20 ILCS 2215/4-2  from Ch. 111 1/2, par. 6504-2

    Amends the Illinois Health Finance Reform Act. Provides that claims and encounter data required to be submitted by hospitals and ambulatory surgical treatment centers shall state the percentage of claims and encounter data that is attributable to administrative costs and provide an explanation of all assumptions and factors used to calculate such percentages.


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A BILL FOR

 

HB1562LRB097 06679 KTG 46765 b

1    AN ACT concerning State government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Health Finance Reform Act is
5amended by changing Section 4-2 as follows:
 
6    (20 ILCS 2215/4-2)  (from Ch. 111 1/2, par. 6504-2)
7    Sec. 4-2. Powers and duties.
8    (a) (Blank).
9    (b) (Blank).
10    (c) (Blank).
11    (d) Uniform Provider Utilization and Charge Information.
12        (1) The Department of Public Health shall require that
13    all hospitals and ambulatory surgical treatment centers
14    licensed to operate in the State of Illinois adopt a
15    uniform system for submitting patient claims and encounter
16    data for payment from public and private payors. This
17    system shall be based upon adoption of the uniform
18    electronic billing form pursuant to the Health Insurance
19    Portability and Accountability Act.
20        (2) (Blank).
21        (3) The Department of Insurance shall require all
22    third-party payors, including but not limited to, licensed
23    insurers, medical and hospital service corporations,

 

 

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1    health maintenance organizations, and self-funded employee
2    health plans, to accept the uniform billing form, without
3    attachment as submitted by hospitals pursuant to paragraph
4    (1) of subsection (d) above, effective January 1, 1985;
5    provided, however, nothing shall prevent all such third
6    party payors from requesting additional information
7    necessary to determine eligibility for benefits or
8    liability for reimbursement for services provided.
9        (4) By no later than 60 days after the end of each
10    calendar quarter, each hospital licensed in the State shall
11    electronically submit to the Department inpatient and
12    outpatient claims and encounter data related to surgical
13    and invasive procedures collected under paragraph (5) for
14    each patient. Claims and encounter data required to be
15    submitted under this Section shall state the percentage of
16    claims and encounter data that is attributable to
17    administrative costs and provide an explanation of all
18    assumptions and factors used to calculate such
19    percentages.
20        By no later than 60 days after the end of each calendar
21    quarter, each ambulatory surgical treatment center
22    licensed in the State shall electronically submit to the
23    Department outpatient claims and encounter data collected
24    under paragraph (5) for each patient, provided however,
25    that, until July 1, 2006, ambulatory surgical treatment
26    centers who cannot electronically submit data may submit

 

 

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1    data by computer diskette. For hospitals, the claims and
2    encounter data to be reported shall include all inpatient
3    surgical cases. Claims and encounter data submitted under
4    this Act shall not include a patient's name, address, or
5    Social Security number. Claims and encounter data required
6    to be submitted under this Section shall state the
7    percentage of claims and encounter data that is
8    attributable to administrative costs and provide an
9    explanation of all assumptions and factors used to
10    calculate such percentages.
11        (5) By no later than January 1, 2006, the Department
12    must collect and compile claims and encounter data related
13    to surgical and invasive procedures according to uniform
14    electronic submission formats as required under the Health
15    Insurance Portability and Accountability Act. By no later
16    than January 1, 2006, the Department must collect and
17    compile from ambulatory surgical treatment centers the
18    claims and encounter data according to uniform electronic
19    data element formats as required under the Health Insurance
20    Portability and Accountability Act of 1996 (HIPAA).
21        (6) The Department shall make available on its website
22    the "Consumer Guide to Health Care" by January 1, 2006. The
23    "Consumer Guide to Health Care" shall include information
24    on at least 30 inpatient conditions and procedures
25    identified by the Department that demonstrate the highest
26    degree of variation in patient charges and quality of care.

 

 

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1    By no later than January 1, 2007, the "Consumer Guide to
2    Health Care" shall also include information on at least 30
3    outpatient conditions and procedures identified by the
4    Department that demonstrate the highest degree of
5    variation in patient charges and quality care. As to each
6    condition or procedure, the "Consumer Guide to Health Care"
7    shall include up-to-date comparison information relating
8    to volume of cases, average charges, risk-adjusted
9    mortality rates, and nosocomial infection rates and, with
10    respect to outpatient surgical and invasive procedures,
11    shall include information regarding surgical infections,
12    complications, and direct admissions of outpatient cases
13    to hospitals for selected procedures, as determined by the
14    Department, based on review by the Department of its own,
15    local, or national studies. Information disclosed pursuant
16    to this paragraph on mortality and infection rates shall be
17    based upon information hospitals and ambulatory surgical
18    treatment centers have either (i) previously submitted to
19    the Department pursuant to their obligations to report
20    health care information under this Act or other public
21    health reporting laws and regulations outside of this Act
22    or (ii) submitted to the Department under the provisions of
23    the Hospital Report Card Act.
24        (7) Publicly disclosed information must be provided in
25    language that is easy to understand and accessible to
26    consumers using an interactive query system. The guide

 

 

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1    shall include such additional information as is necessary
2    to enhance decision making among consumer and health care
3    purchasers, which shall include, at a minimum, appropriate
4    guidance on how to interpret the data and an explanation of
5    why the data may vary from provider to provider. The
6    "Consumer Guide to Health Care" shall also cite standards
7    that facilities meet under state and federal law and, if
8    applicable, to achieve voluntary accreditation.
9        (8) None of the information the Department discloses to
10    the public under this subsection may be made available
11    unless the information has been reviewed, adjusted, and
12    validated according to the following process:
13            (i) Hospitals, ambulatory surgical treatment
14        centers, and organizations representing hospitals,
15        ambulatory surgical treatment centers, purchasers,
16        consumer groups, and health plans are meaningfully
17        involved in providing advice and consultation to the
18        Department in the development of all aspects of the
19        Department's methodology for collecting, analyzing,
20        and disclosing the information collected under this
21        Act, including collection methods, formatting, and
22        methods and means for release and dissemination;
23            (ii) The entire methodology for collecting and
24        analyzing the data is disclosed to all relevant
25        organizations and to all providers that are the subject
26        of any information to be made available to the public

 

 

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1        before any public disclosure of such information;
2            (iii) Data collection and analytical methodologies
3        are used that meet accepted standards of validity and
4        reliability before any information is made available
5        to the public;
6            (iv) The limitations of the data sources and
7        analytic methodologies used to develop comparative
8        provider information are clearly identified and
9        acknowledged, including, but not limited to,
10        appropriate and inappropriate uses of the data;
11            (v) To the greatest extent possible, comparative
12        hospital and ambulatory surgical treatment center
13        information initiatives use standard-based norms
14        derived from widely accepted provider-developed
15        practice guidelines;
16            (vi) Comparative hospital and ambulatory surgical
17        treatment center information and other information
18        that the Department has compiled regarding hospitals
19        and ambulatory surgical treatment centers is shared
20        with the hospitals and ambulatory surgical treatment
21        centers under review prior to public dissemination of
22        the information and these providers have an
23        opportunity to make corrections and additions of
24        helpful explanatory comments about the information
25        before the publication;
26            (vii) Comparisons among hospitals and ambulatory

 

 

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1        surgical treatment centers adjust for patient case mix
2        and other relevant risk factors and control for
3        provider peer groups, if applicable;
4            (viii) Effective safeguards to protect against the
5        unauthorized use or disclosure of hospital and
6        ambulatory surgical treatment center information are
7        developed and implemented;
8            (ix) Effective safeguards to protect against the
9        dissemination of inconsistent, incomplete, invalid,
10        inaccurate, or subjective provider data are developed
11        and implemented;
12            (x) The quality and accuracy of hospital and
13        ambulatory surgical treatment center information
14        reported under this Act and its data collection,
15        analysis, and dissemination methodologies are
16        evaluated regularly; and
17            (xi) Only the most basic hospital or ambulatory
18        surgical treatment center identifying information from
19        mandatory reports is used. Information regarding a
20        hospital or ambulatory surgical center may be released
21        regardless of the number of employees or health care
22        professionals whose data are reflected in the data for
23        the hospital or ambulatory surgical treatment center
24        as long as no specific information identifying an
25        employee or a health care professional is released.
26        Further, patient identifiable information is not

 

 

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1        released. The input data collected by the Department
2        shall not be a public record under the Illinois Freedom
3        of Information Act.
4        None of the information the Department discloses to the
5    public under this Act may be used to establish a standard
6    of care in a private civil action.
7        (9) The Department must develop and implement an
8    outreach campaign to educate the public regarding the
9    availability of the "Consumer Guide to Health Care".
10        (10) By January 1, 2006, the Department must study the
11    most effective methods for public disclosure of patient
12    claims and encounter data and health care quality
13    information that will be useful to consumers in making
14    health care decisions and report its recommendations to the
15    Governor and to the General Assembly.
16        (11) The Department must undertake all steps necessary
17    under State and Federal law to protect patient
18    confidentiality in order to prevent the identification of
19    individual patient records.
20        (12) The Department must adopt rules for inpatient and
21    outpatient data collection and reporting no later than
22    January 1, 2006.
23        (13) In addition to the data products indicated above,
24    the Department shall respond to requests by government
25    agencies, academic research organizations, and private
26    sector organizations for purposes of clinical performance

 

 

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1    measurements and analyses of data collected pursuant to
2    this Section.
3        (14) The Department, with the advice of and in
4    consultation with hospitals, ambulatory surgical treatment
5    centers, organizations representing hospitals,
6    organizations representing ambulatory treatment centers,
7    purchasers, consumer groups, and health plans, must
8    evaluate additional methods for comparing the performance
9    of hospitals and ambulatory surgical treatment centers,
10    including the value of disclosing additional measures that
11    are adopted by the National Quality Forum, The Joint
12    Commission on Accreditation of Healthcare Organizations,
13    the Accreditation Association for Ambulatory Health Care,
14    the Centers for Medicare and Medicaid Services, or similar
15    national entities that establish standards to measure the
16    performance of health care providers. The Department shall
17    report its findings and recommendations on its Internet
18    website and to the Governor and General Assembly no later
19    than July 1, 2006.
20    (e) (Blank).
21(Source: P.A. 93-144, eff. 7-10-03; 94-27, eff. 6-14-05.)